Endoscopic drainage of pancreatic pseudocysts

Abstract

Summary. Seventeen patientswith pancreatic pseudocysts were treated by endoscopic drainage. In nine cases we performed endoscopic retrograde pancreatic drainage (ERPD) by inserting 7-Fr pigtail catheters via the papilla into the cyst or into the main pancreatic duct. In two cases transduodenal cystotomy (ECD) and in eight cases transgastral cystotomy (ECG) are performed by using coagulator and papillotome. In five cases of ECG an endoprosthesis was inserted into the cyst. In two cases combination therapy of ERPD and ECG was performed. All patients reported reduction of continuous pain and postprandial epigastralgia after placement of endoprosthesis. After disappearance of symptoms and abnormal endoscopic findings within a period of 2-12 months the drainage tubes were removed. In one case postoperative dislocation of the prosthesis was observed; no serious complication was not encountered. The period of observation varied from 5 to 40 months. Two patients are presently under treatment with endoprostheses. Endoscopic drainage yielded good results in the treatment of pancreatic pseudocysts. Key words: Pancreatic pseudocyst-Endoscopic drainage -Transduodenal cystotomyPancreatic pseudocysts require drainage if they cause symptoms such as pain or loss of appetite or complications like bleeding, infection, or jaundice due to compression of the common bile duct. Asymptomatic but large cysts with a high risk of developing complications should also be treated by drainage. Many therapeutic procedures such as external drainage with nasocystic tubes or CT and sonographically guided percutaneous drainages exist.The rates of recurrence, however, amount to 20-25%, and there are many cases of persistent pancreatiOffprint requests to: M. Dohmoto cocutaneous fistula. The conventional surgical treatment by construction of an internal connection between the cyst and the gastrointestinal tract has a high rate of complication and mortality. So endoscopic procedures with the advantage of less complications and less discomfort for the patient have been developed recently.

Laparoscopic drainage of pancreatic pseudocysts

“…There were no conversions. Mean surgical time was 4 h (range, [3][4][5][6]. Median hospital stay was 7 days (range, 4 to 15).…”

“…Resolution of the PP can be as high as 94% with persistent long-term cure of 90%. Overall, morbidity [3,6,9,15]. Some authors have stated that when endoscopic and radiologic drainage fail, there is increased surgical morbidity and prolonged hospitalization [13].…”

Endoscopic treatment of chronic pancreatitis

“…Results of trans-papillary drainage have been also reported in six series from 1991 to 1995 including 121 cysts (Table 4) [48,53,[55][56][57] . Symptom-free rates were 87% (76%-87%) and healing rates of cysts were 84% (76%-94%).…”

“…Haemorrhage depends on the presence of pericystic or peridigestive vessels, segmental portal hypertension and the haemorrhagic content of the cyst. Perforation depends on the distance between the digestive-wall and (Table 3) [48][49][50][51][52][53] . Mean rate of healing, failure and recurrence were respectively 78% (51%-82%), 5.5% (0%-16%) and 6.5% (3%-13%).…”

Current status of laparoscopic surgery of the pancreas

“…[43][44][45][46] There are also concerns with tract infection, external pancreatic fistula, and bleeding. 1,44,47 Laparoscopic treatment of pancreatic pseudocysts should follow the same basic tenets of open internal drainage, principally to the stomach, duodenum, or jejunum.…”